| NPI | 1376813410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY WILLIAM LATSKO Director 757-240-1067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717001186) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2012-01-09 |